Physician Groups React to 'Fiscal Cliff' Deal

Organized medicine was generally pleased that the "fiscal cliff" deal reached this week averted cuts in Medicare reimbursement, but groups expressed concern about healthcare budget cuts that may be coming in a few months.

The deal, passed by the House and Senate on Tuesday and signed by President Obama on Thursday, put off for a year the 26.5% cut in physician reimbursement mandated by Medicare's sustainable growth rate (SGR) formula scheduled for Jan. 1 and pushed back another 2% cut for 2 months.

The Medicare provisions were part of a broader deal to avert the so-called "fiscal cliff," a series of dramatic spending cuts and sharp tax increases. The 2% cut that was pushed back for 2 months is part of a larger package of across-the-board cuts in federal spending known as "sequestration," which includes a 9.4% cut in most parts of defense spending and an 8.2% cut for most nondefense agencies -- including the Department of Health and Human Services -- in fiscal 2013.

For now, all those cuts are delayed pending further action by Congress.

The American Association of Orthopaedic Surgeons (AAOS) in Rosemont, Ill., had a response to the "fiscal cliff" compromise that was typical of the reaction of many medical groups. "While the AAOS is pleased that the American Taxpayer Relief Act of 2012 has temporarily averted the sequestration and Medicare physician payment cuts and has prevented our nation from falling off the 'fiscal cliff,' a permanent solution to both of these issues is vital to the health of our patients and our economy," said AAOS President John R. Tongue, MD, in a statement.

In addition to the short-term payment fix, the AAOS "also urges the 113th Congress to work with the physician community to eliminate the SGR and develop a sustainable payment system that rewards effective and accountable healthcare for our patients," Tongue said.

Clifford A. Hudis, MD, president-elect of the American Society of Clinical Oncology (ASCO) in Alexandria, Va., had more specific -- and slightly harsher -- comments. "This end-of-year crisis management once again demonstrates the critical need for fundamental reform of the Medicare reimbursement system," Hudis said in a statement. "Unfortunately, the triple-threat of sequestration cuts to cancer research, physician reimbursement, and drug review oversight ... is only temporarily averted."

ASCO "will continue to advocate for the protection of critical funding to the National Cancer Institute, Medicare, and the Food and Drug Administration," he said.

Hudis also brought up quality reporting -- an issue not mentioned by other groups. He said the association was pleased that the bill passed this week "includes a provision that allows physicians to satisfy federal quality reporting requirements through clinical data registries approved by HHS. By allowing these as an alternative to quality reporting currently required by the Centers for Medicare and Medicaid Services, Congress has taken a critical first step towards a more robust quality monitoring system in cancer."

American College of Cardiology president William A. Zoghbi, MD, said in a statement that Congress should use this deal "as an opportunity to enact meaningful healthcare payment reform that rewards appropriate, patient-centered care ... The future sustainability of the Medicare program depends on this transition."

But not all groups were as positive or as optimistic.

"No 'SGR fix' is going to solve the problem of access to care," the Association of American Physicians and Surgeons, which promotes the practice of private medicine, said in a statement. "Physicians cannot continue to serve their patients under a regime of price controls and costly, byzantine regulations, in an atmosphere of constant uncertainty and draconian threats.

"Congress is unwilling to confront the reality that Medicare is bankrupt and unsustainable," the statement continued. "It has made more than $50 trillion in promises without any way to pay for them."

The American Society of Hematology (ASH), in Washington, was especially concerned about possible cuts to the National Institutes of Health (NIH) if sequestration does occur. Many ASH members rely on NIH funding for their research, ASH president Janis A. Abkowitz, MD, noted in a statement. "Thanks to congressional action late New Year's Day ... our members' work to develop cures for some of America's most deadly diseases will not be interrupted today."

However, she noted, "the Society is keenly aware that NIH and other nondefense discretionary programs are not safeguarded from future cuts," she continued. "Given this uncertain outlook, ASH will continue to urge lawmakers to provide balanced deficit reduction that does not further cut discretionary programs like NIH."

The Infectious Diseases Society of America, headquartered in Arlington, Va., was particularly concerned about funding for the National Institute of Allergy and Infectious Diseases (NIAID). "They're doing a lot of great work on antibiotic resistance, which has been our top policy priority for the last few years now," Amanda Jezek, the society's director of government relations, told MedPage Today in an interview.

"This past year NIAID announced it was launching a clinical trials network on antibiotic-resistant infections," which will really move things forward and help researchers come up with new diagnostic tools to identify the infections as well as ways to treat them, Jezek continued. "If we wind up seeing big funding cuts, programs like these are certainly in jeopardy."

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